The study of the intermissions which occur in the course of general paralysis is not the least interesting chapter in the history of this disease. Is it not a matter of surprise, that an affection which occasions such grave disturbances of the cerebral organ should undergo ameliorations so pronounced as might well be taken for a real cure, did not the experience of each day teach us that it is but arrested for a longer or shorter time, and that sooner or later the paralysis resumes its fatal course. Have not even alienists asserted that they have cured demented paralytics ? The existence of intermission in the course of general paralysis does not at the present time need to be demonstrated. It is enough to glance at the treatises of MM. Calmeil and Bayle, to find the most remarkable examples of it.

The cases which one generally meets in an asylum often diner in no small degree from those of ordinary practice. To ensure sleep in a patient under delirium tremens, or other such short-lived malady, is to establish cure at once, and the result melts into the satisfactory finish of “cured in a few days thereafter.” Fortunately or unfortunately, such bright prospects are not often held out to asylum practitioners, but yet the efficient means for procuring sleep are frequently not less clamant. In many of our cases there is no hope of recovery, even although sleep of the soundest nature was obtained; nevertheless, it is no mean aim to command such for one who, during a paroxysm, passes night after night ill a morbid condition, whether wildly shouting and beating at the walls and doors he disturb the rest of all, and prostrate himself, or with a quieter demeanour remain in bed with unclosed lids in melancholy whispering. The boon conferred on the household in the former, and on the patients in both cases, is sufficiently obvious; and it is for such chronic, not less than the acute cases, that I would recommend the subcutaneous injection. We cannot, indeed, say in such cases that the patient went out cured shortly after, for that they may never do; but the comfort and advantage resulting from their successful narcotism must be familiar to all in our department. Of acute cases I need say little; in them the state of matters is conspicuous enough.

History of the case.—G. C—, No. —, æt. 41, single, a Scotchman, was admitted into the Hayward's Heath Asylum on the 31st October, 1860.

In 1856, this patient was committed for seven days to Maidstone Gaol for some breach of the peace while under the influence of drink, and he then stabbed a fellow-prisoner (who subsequently died of the wound), whom he had never seen before, and who had in no way provoked or offended him. His own account of the transaction is that, on the second or third day after his committal, he was coming out of the chaplain's room, and being left alone in the corridor, a sudden idea took possession of his mind that he was in a place where men were cut up for preserved meat for the navy, and that seeing a carpenter's chisel lying on the ground (some repairs were in progress), he took it up, and blindly attacked the first prisoner he met.

It is only after much thinking, and with much hesitation, that I venture to advocate in the following pages, principles as to the size and construction of lunatic asylums, which I believe to be at variance with those upheld by the highest authorities on this subject; but the question how provision may be best made for the enormous number of lunatics now known to exist in every civilized country, is one of such importance, and still so far from having received a satisfactory answer, that it seems a matter of duty on the part of every one who has had favourable opportunities for considering the matter, to place his views before the public. In this, as in other questions, full and free discussion seems to offer the best chance for a speedy arrival at the truth, and though my views may not meet public approval, yet their publication may contribute to enquiry, and thus tend to a satisfactory solution of the question. I am of opinion, that asylums of large size are the best adapted for the curative and humane treatment of the insane, and whilst I am not prepared to say what limit should be put to the size of an asylum, I do not consider that Colney Hatch, which is the largest of our public asylums, would be too large, if its internal construction had been arranged so as to meet certain modifications in the principles of management, which, in my mind, would be advisable in all asylums, but which are still more requisite in those of large than of small size.

The physical symptoms attending the general paralysis of the insane have been shown to present in their progress three well-defined stages. Some of the earliest physical signs—any one of which associated with a particular form of insanity will almost infallibly indicate the first stage of this special disorder—are the intermittent pulse, the irregular or contracted pupil, the quivering lip or embarrassed articulation. The second stage is marked by loss of power in the upper extremities, by a gait more or less unsteady, by diminished sensation in the cutaneous nerves, or by the loss of some of the special senses. In the third period the disease approaches its climax, in an entire want of motory power, and by an impairment of all the nervous functions so universal, that although organic life may, under careful treatment, be prolonged for a considerable time, the patient may be said to exist rather than to live. Epileptiform attacks may precede or accompany any one of these stages. They sometimes very distinctly mark out their boundaries, or the disorder may run its course without any recognised convulsive seizures.

The particulars of the new Acts relative to the care and treatment of lunatics will probably be before the public at the time of the appearance of this number of the Journal. The proposed Act affecting Chancery lunatics has already appeared, and requires no particular comment. It is to be hoped, however, that the enormous expense attendant on opposed commissions may be diminished. The absurd reference of one of the most delicate and difficult of metaphysical questions to a jury will still, no doubt, prevail.